多节段腰椎后路椎体间及后外侧融合椎弓根螺钉内固定治疗老年骨质疏松骨折合并胸腰椎后凸畸形  

Multiple posterior lumbar interbody fusion and posterolateral fusion instrumentation for thoracolumbar kyphosis and osteoporotic fracture in older adults

作　　者：李青松 刘少喻[3] 尹宗生[1] Li Qingsong;Liu Shaoyu;Yin Zongsheng(Department of Orthopedics,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,Anhui Province,China;Department of Spinal Surgery,Anhui No.2 Provincial People’s Hospital,Hefei 230011,Anhui Province,China;Department of Spinal Surgery,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,Guangdong Province,China)

机构地区：[1]安徽医科大学第一附属医院骨科,安徽省合肥市230022 [2]安徽省第二人民医院脊柱外科,安徽省合肥市230011 [3]中山大学附属第一医院脊柱外科,广东省广州市510080

出　　处：《中国组织工程研究》2019年第4期512-517,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:随着中国人口老龄化程度不断加重,骨质疏松性骨折合并后凸畸形发病率逐渐增高。对该病的手术方式是否需要截骨矫形尚存在争议。目的:探讨多节段腰椎后路椎体间融合及后外侧融合椎弓根螺钉内固定矫形对老年骨质疏松骨折合并胸腰椎后凸畸形患者的临床疗效和矢状位平衡的改善情况。方法:回顾性研究共纳入90例老年骨质疏松的患者,其中手术组40例为合并胸腰段后凸畸形的患者,在抗骨质疏松治疗基础上,通过多节段腰椎后路椎体间融合及后外侧融合椎弓根螺钉内固定进行矫形;非手术组50例存在骨质疏松,但无后凸畸形。通过对患者术前和术后随访,观察手术组Oswestry功能障碍指数、目测类比评分变化;对比2组间脊柱骨盆矢状位参数如胸椎后凸角、腰椎前凸角、矢状面躯干偏移、骨盆倾斜角和骨盆入射角,评估患者矢状面平衡的改善;通过日本骨质疏松生活质量评分对患者的生活质量进行评估。结果与结论:(1)手术组患者术后目测类比评分,Oswestry功能障碍指数均较术前明显改善;(2)手术组术后胸椎后凸角、矢状面躯干偏移和骨盆倾斜角均较术前明显改善;(3)生活质量方面,手术组术后姿势和形态评分、恐惧和心理评分较术前有明显改善,但仍低于非手术组(P <0.05);手术组术后的疼痛评分、一般健康评分与非手术组之间差异无显著性意义(P> 0.05);(4)通过多节段腰椎后路椎体间融合及后外侧融合椎弓根螺钉内固定矫形能有效改善老年骨质疏松合并胸腰椎后凸畸形患者的矢状面平衡,并提高患者的生活质量。BACKGROUND:With aged trend of population in China becoming severe,the incidence of osteoporosis fracture with thoracolumbar kyphosis is increasing.Whether osteotomy is required or not still remains a controversy.OBJECTIVE:To evaluate the clinical efficacy and improvement in sagittal vertical axis after multiple posterior lumber interbody fusion and posterolateral fusion instrumentation for patients with osteoporotic fracture with thoracolumbar kyphosis.METHODS:Totally 90 cases of senile osteoporosis were included in the retrospective study.Operation group included 40 patients suffering osteoporosis and thoracolumbar kyphosis who underwent anti-osteoporosis treatment and multilevel posterior lumbar interbody fusion and posterolateral fusion instrumentation.Control group included 50 patients with osteoporotic without kyphosis.The Oswestry Disability Index and Visual Analogue Scale scores were compared between two groups after follow-up.Spinoplevic parameters,such as thoracic kyphosis angle,lumbar lordosis angle,sagittal vertical axis,pelvic title and pelvic incidence were compared to evaluate the improvement in the sagittal vertical axis.The quality of life was evaluated with the Japanese Osteoporosis Quality of Life Questionnaire scores.RESULTS AND CONCLUSION:(1)The Visual Analogue Scale and Oswestry Disability Index scores in the operation group were improved significantly compared the baseline.(2)The postoperative thoracic kyphosis angle,sagittal vertical axis,and pelvic title in the operation group were significantly improved compared with the baseline.(3)The postoperative posture,figure scores,and fear and physiological scores in the operation group were significantly improved compared with the baseline,but lower than those in the control group(P<0.05).There were no significant differences in the pain and health scores between two groups postoperatively(P>0.05).(4)These results indicate that spinal alignment and quality of life are significantly improved after corrective spinal surgery using multilevel posteri

关 键 词：胸腰椎 骨质疏松性骨折 腰椎后路椎体间融合术 椎体融合 胸腰椎后凸畸形 胸椎 腰椎 脊柱后凸 脊柱融合术 生活质量 组织工程 

分 类 号：R459.9[医药卫生—治疗学]